This case study was developed through interviews between the Chief Medical Officer, Chief Technology Officer, Senior Clinical Governance Manager of the client organisation, with Professor Amar Shah (Strategic Advisor at MEG, and National Clinical Director for Improvement in England).
The CHALLENGE
The client organisation is a private healthcare group operating in 14 countries supporting 100,000 patients.
The scale of their operations brings significant complexity and challenge – working with patients from vastly different cultures and demographics. As an example the average age of patients can vary by almost two decades between some of the countries they operate in. Operating in different countries also exposes the organisation to different regulatory practices that need to be complied with, alongside differences in the extent healthcare needs are covered by the public sector and/or private healthcare.
Despite this variation across different contexts, the team still wants to be able to standardise elements of clinical governance across all its operations and staff, working in different countries and speaking different languages. To illustrate this challenge, even the release of a new policy brings complexity – with the need to ensure it is translated into the 9-10 languages that are represented across the breadth of the organisation.
Prior to the introduction of MEG, the organisation was using a small, niche digital system to support quality governance – but the functionality was limited, requiring lots of additional effort for translation, for example, or building workflows for audit. These limitations were some of many that identified the need for change.
““We wanted to work with a provider that is experienced across multiple countries, understands particularly clinical risk and clinical audit, not just general quality management across multiple industries. That journey led us to MEG, because MEG ticked the boxes for all of those and they also have a really good understanding of what quality and safety means in healthcare.” ”
The Solution
MEG was an attractive solution for a number of reasons. MEG brought global experience, and the ability for the platform to operate in multiple languages. MEG had a proven track record of successful implementations in complex environments, such as England’s NHS. The look and feel of the browser and app interface was attractive. The interactions with MEG’s team felt good, trusting and values-based – a really key element when partnering for the long-term with a digital supplier.
But ultimately, what the CMO really cared about was that staff across the global operations of the company could easily report an incident, complete an audit, access a policy, and act on this. And MEG made this simple – all in one place, with an intuitive layout.
Their team has found the MEG team to be responsive, and keen to make the platform work how they need it to. The key was a close relationship between their Senior Clinical Governance Manager, and Angeline, Senior Implementation Specialist at MEG. They worked closely together during the initial 9 month design phase – taking the existing platform for safety incidents and audits, working out how to transition this to MEG and then build additional functionality.
The approach to implementation has been to engage closely with both leaders in each country, but more critically, with staff on the ground. The system was first implemented in Colombia. After the platform had been designed, it was shared with the country leadership first. Videos were developed, to help staff learn how to access the system, how to report a safety event etc. Four clinics were chosen to test the system. Activities were organised to engage clinical staff, through short training sessions, testing different functionality together, creating engaging ways to capture attention and interest. Key to engagement was finding small, simple ideas from staff that would make the platform better, and working with MEG to implement these rapidly (within a day usually), and then feeding this back to the clinical teams. Surveys were used to capture feedback. Staff across the organisation have shared positive feedback about their experience of using the platform.
Outcomes
All corporate policies for the organisation now sit in the single place within MEG, in their policy management solution. The platform enables translation and adaptation of corporate policies, so that they can be made available to each country team.
“We’re using MEG for our document workflows for all of our policies and procedures. It’s given us a platform where we have one central place of record and we’ve chosen to put all our operational policies and procedures alongside our clinical ones, the MEG platform has allowed us to have everything in one place with the same workflow capabilities. Those policies are replicated to each of the 14 countries either directly translated or with a slight adaptation based on local regulatory requirements. The role of MEG in managing that and having all the necessary approvals in place is really important to us because we have a lot of policies. That, working alongside the audit and safety events gives us a really good platform for managing our key quality processes.”
The information that staff enter into MEG is run through a translation engine – so that staff can enter information in their natural language, and MEG is able to translate this. This has saved time that was previously needed to extract information and translate it manually, in order to interpret and analyse.
Data from MEG is now integrated into the organisation’s data warehouse, so that it can be viewed, analysed and interrogated within the organisation’s own business intelligence platform. This is critical to enable triangulation of indicators from different data sources, including workforce and finance. This has enabled their executive team much better sight of quality and safety issues across the entirety of the global operations. It has also allowed the development of early warning indicators, using a set of safety flags to identify when a particular sequence of events is reported in an area – allowing the corporate team to alert the country team, and potentially avoid future safety events.
“The dashboards are changing the reality in the clinics. They no longer need to extract an Excel report to understand what is going on and that’s key for us at the country, clinic and international level. They now want to bring so much more onto the MEG system. The feedback has been so good they want MEG doing even more for them.”
Ultimately, the introduction of MEG has supported the growth of a stronger safety culture across the business. In Chile, for example, where there have been limited national policies encouraging safety reporting, the introduction of MEG encouraged staff to go beyond just reporting those incidents required by the regulator, but also sharing near misses and low harm incidents. This provided the country team with much better intelligence about safety, enabling them to predict and prevent harm.
One incredible outcome from this was the reduction in hospitalisations amongst the population of patients needing renal dialysis. Prior to the introduction of MEG, the hospitalisation rate was 0.7 admissions per patient, per year. Hospitalisations are an important outcome to track and to avoid, as this obviously creates risk for the patient and cost for the system, but each hospitalisation also reduces life expectancy for the patient. After the introduction of MEG, hospitalisations reduced to 0.55 per patient, per year. The country team in Chile were clear that this was due to the safety culture that had been strengthened and reinforced by the MEG platform.
“We track hospitalisations as a metric. Hospitalisation reduction is something that’s really important for us. After 18 months in operation in Chile, hospitalisations went from 0.7 per patient, per year to 0.55 which is about a 20% reduction. When I speak to our CMO in Chile and say it’s great to see this and ask what’s been the change? She said ‘MEG’.”
The audit function in MEG has been a big hit too. Previously audits were seen as burdensome, creating paperwork and taking people away from their caring role. Now, staff can use the app, take photos to document, and both save time and engage better with the audit cycle.
“The quality of data input because of access improvements and availability, I think MEG has given us that. The quality of our reporting, particularly when we’re so dependent on data driven KPI’s and OKR’s for reviewing at the very senior level and tracking our progress across all the countries on how we’re continuing to improve our safety reporting and patient outcomes, it’s dramatically improved our data quality.”
In Saudi Arabia, the MEG platform has allowed the team to now move to strengthen the way in which safety incidents are investigated. Incidents are coded, and incident analysis can be scored – allowing them to provide feedback to country teams, reinforcing good practice and encouraging more rigorous incident analysis and response.
As to the future, the organisation is looking forward to the final elements of deploying the platform in China and the UK. The UK deployment will be heavily focused on the Patient Safety Incident Response Framework (PSIRF), a key part of the NHS patient safety strategy replacing the 2015 Serious Incident Framework. PSIRF shifts focus from blame to learning, requiring the involvement of patients/families, and improving safety through better systems. The organisation will use the learning from this to start deploying elements of PSIRF and Safety-II thinking to the rest of the global operations.
There are also real opportunities to utilise artificial intelligence – linking the MEG database with their in-house large language model, to enable even better safety incident management and feedback response, and also enabling big data analysis of the large volume of incidents now being recorded through the platform.
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